Is Idiopathic Hypersomnia a Disabling Condition?

Idiopathic hypersomnia (IH) is a chronic neurological sleep disorders characterized by excessive daytime sleepiness, unrefreshing sleep, and cognitive difficulties. While it is often misunderstood and not always recognized as a disabling condition, its severe symptoms can significantly impair a person’s ability to work and perform daily activities. Under certain conditions, individuals with idiopathic hypersomnia may qualify for disability insurance benefits.

Have you or someone you know experienced challenges with idiopathic hypersomnia disability claims? This blog explores how idiopathic hypersomnia can be disabling, the obstacles claimants face, and strategies to strengthen your case.

Why Idiopathic Hypersomnia Can Be a Disabling Condition

The symptoms of idiopathic hypersomnia can profoundly affect a person’s ability to work. Excessive daytime sleepiness and unrefreshing sleep make it hard to focus, meet deadlines, or sustain productivity throughout the day. As a result, idiopathic hypersomnia is often the basis for both short-term and long-term disability claims.

More specifically, the severe fatigue caused by IH can impede an individual’s ability to perform both the physical and cognitive duties of their occupation. Furthermore, the ‘brain fog’ associated with IH and a lack of sleep can significantly impact one’s ability to perform the cognitive demands of their job.

Not only is IH capable of rendering someone unable to work – it can also prevent the performance of even the most basic daily tasks. It can be next to impossible for someone with IH to sustain a routine of waking in the morning before work hours and carrying on throughout the day without requiring a nap.

Challenges in Proving Idiopathic Hypersomnia Disability Claims

To qualify for disability benefits, claimants must demonstrate that they cannot perform the main duties of their regular occupation. This can be particularly challenging when dealing with idiopathic hypersomnia, as claimants must convince their insurers of the severity of their condition.

Often times, insurers require ‘objective evidence’ to prove the disabling nature of idiopathic hypersomnia symptoms. This demand can be problematic because, unlike other disabling medical conditions, there are no MRIs, blood tests, or similar diagnostic tools to confirm idiopathic hypersomnia. Instead, the diagnosis often relies on self-reported symptoms.  Insurers often dismiss the severity of IH or question eligibility for benefits due to the lack of definitive medical testing.

Workplace accommodations might reduce the need for full monthly disability benefits, but part-time disability benefits may still be an option for those working in a limited capacity. However, many individuals with idiopathic hypersomnia are unable to sustain normal work hours due to overwhelming fatigue and cognitive impairments. This inability to maintain a consistent schedule often underscores the need for full disability benefits.

Evidence Needed to Support Idiopathic Hypersomnia Claims

There are several pieces of evidence you can submit with your disability claim to establish the severity of your IH symptoms.

Some of these can satisfy an insurer’s demand for objective evidence. One example is your score on the Epworth Sleepiness Scale, a self-evaluation that scores the severity of your daytime sleepiness. A multiple sleep latency test (“MSLT”) can also measure the extent of your daytime sleepiness.

Similarly, you can undergo a polysomnography (a.k.a. sleep study) to confirm any issues with your sleep cycles that may be the cause of your IH symptoms. A maintenance of wakefulness test can also establish how alert you are able to stay throughout the day.

In addition to these diagnostic tools, strong medical records are critical. Your medical records should detail the frequency, severity, and functional limitations caused by your symptoms. For example, include notes on how cognitive fog impacts your ability to focus for extended periods or how excessive fatigue prevents you from completing daily tasks.

Another important consideration is to undergo neuropsychological testing. This comprehensive examination is used to objectively document any cognitive deficits caused by your lack of sleep. These tests can measure specific impairments, such as memory problems, difficulty concentrating, or challenges with problem-solving, which are often critical to proving your inability to work.

Finally, testing results like the Epworth Sleepiness Scale or MSLT should include an interpretation from a specialist. A neurologist or sleep specialist can explain how these results demonstrate the disabling effects of idiopathic hypersomnia, adding credibility to your claim.

You will also need to prove that your debilitating symptoms are caused by idiopathic hypersomnia, rather than mental illness such as anxiety, depression, or similar psychiatric disorders. This is because most private disability policies limit the amount of time one can receive benefits due to a mental disorder to 24 months.

Strategies for Strengthening Idiopathic Hypersomnia Disability Claims

There are a number of things you can do to strengthen your disability claim. The most important of those is to hire a disability attorney who has the experience necessary to guide you through the disability application process. Perhaps the next most important is to submit the results of any of the testing measures discussed above.

Another important strategy is to be sure that your treating doctors support your claim. Without their support, it will be hard to convince your disability insurer that you are entitled to benefits. Your doctors will need to explain to the insurer which specific symptoms they have observed and how they directly impact your ability to work. The more specific, the better.

Relatedly, your medical records from your treating doctors are important to demonstrating your disability. These will document your doctors’ specific findings and document what you discussed at your various appointments.

Another piece of evidence is a personal statement why, in your own words, you are unable to work due to your IH symptoms. Similarly, you should submit statements from family and friends who have observed your IH symptoms and resulting difficulties first-hand.

Legal Insights: The Impact of the Scanlon Case on Idiopathic Hypersomnia Claims

DeBofsky Law successfully litigated a case involving IH before the United States Court of Appeals for the Seventh Circuit. In Scanlon v. Life Ins. Co. of N. Am., 81 F.4th 672 (7th Cir. 2023), the Court made clear that disability insurers are required to consider the impact sleep disorders have on the claimant’s ability to perform the cognitive duties of their occupation. Thus, if your occupation requires a lot of thinking and complex problem solving, then your disability insurer must factor that into their decision whether to approve benefits.

Conclusion: How to Strengthen Your Idiopathic Hypersomnia Disability Claim

Idiopathic hypersomnia is a disabling condition that can profoundly impact your ability to work and manage daily life. Navigating the disability claims process for such a complex condition requires a proactive approach, including gathering strong medical evidence, obtaining support from treating physicians, and documenting how your symptoms affect your daily activities.

If you face challenges with your claim, legal precedent like Scanlon provides a roadmap to hold insurers accountable for properly considering the cognitive and physical effects of idiopathic hypersomnia. Working with an experienced disability attorney is crucial to ensuring your claim is handled effectively and your rights are protected.

At DeBofsky Law, we have extensive experience helping clients secure disability benefits for idiopathic hypersomnia and other chronic conditions. Contact us today to schedule a consultation and take the first step toward obtaining the benefits you deserve.

Frequently Asked Questions About Idiopathic Hypersomnia and Disability Claims

What qualifies idiopathic hypersomnia as a disabling condition?

Idiopathic hypersomnia qualifies as disabling when its symptoms, such as excessive daytime sleepiness and cognitive impairments, prevent you from performing the primary duties of your job. Claimants must provide medical evidence (e.g., sleep studies, neuropsychological reports) to demonstrate how the condition limits their functionality.

How do I prove my idiopathic hypersomnia is not a mental health condition?

Many disability policies limit benefits for mental health conditions to 24 months. To avoid this limitation, your medical records should clearly attribute your symptoms (e.g., fatigue, cognitive fog) to idiopathic hypersomnia rather than psychiatric disorders like anxiety or depression. Supporting documentation from a neurologist or sleep specialist is particularly valuable.

Can workplace accommodations affect my disability claim?

Yes, workplace accommodations can impact the outcome of your claim. If accommodations allow you to perform your job in a reduced capacity, you may qualify for partial disability benefits. However, if accommodations are insufficient and you cannot meet the demands of your job, this supports the need for full disability benefits.

Why is legal representation important for idiopathic hypersomnia claims?

Insurers often deny claims due to a lack of ‘objective evidence.’ A disability attorney experienced in idiopathic hypersomnia cases can help gather compelling documentation, address insurer skepticism, and appeal wrongful denials. Attorneys also ensure compliance with policy terms and legal precedents like Scanlon.